Skip to main content
Contact Us 800.227.2345 Help Sign Up For Email

Managing Cancer Care

Back
Download Section as PDF

Getting a Stem Cell or Bone Marrow Transplant

A stem cell transplant (also called a bone marrow transplant) is an important part of treatment for some cancers. Learn what it’s like to get a transplant, from preparation to recovery.

On this page
[show] [hide]

Understanding the benefits and risks

For many people, getting a stem cell transplant can mean a cure or a longer time spent free of disease (in cases like multiple myeloma). But there is also a risk transplant can lead to severe problems or even death.

It’s important to weigh the benefits and risks of stem cell transplant before you start.

Discuss the transplant process and all its effects with your cancer care team. It also helps to talk with others who have already had transplants. You can learn more in Deciding to Have a Stem Cell Transplant.

Finding out if you are eligible

As a first step, the transplant team will evaluate you to see if you are eligible for a stem cell transplant. They will ask you questions and do several types of medical tests. This helps them find out how well your body can handle the transplant process.

Testing and evaluation

This might include tests to look at your organs, called vital organ testing (VOT). It might also include blood tests and a mental health exam.

Blood tests could include:

  • HLA tissue typing (see Finding a Stem Cell Donor)
  • Complete blood count
  • Blood chemistries
  • Screening for viruses like hepatitis B, CMV, and HIVA

Vital organ testing (VOT) could include:

  • Heart tests, such as an EKG (electrocardiogram) or echocardiogram
  • Lung studies, such as a chest x-ray and PFTs (pulmonary function tests)

Other testing could include:

  • Complete health history and physical exam
  • Bone marrow biopsy
  • CT scan or MRI
  • Mental health exam

You may meet with members of the transplant team, such as:

  • Transplant coordinator  
  • Social worker
  • Dentist
  • Dietitian

You will also talk with the transplant finance team about your health insurance coverage and any costs you might have to pay out of pocket.

Transplant eligibility

Stem cell transplants can be an option at almost any age. Your overall fitness and health are often more important than your age.

You might not be eligible for transplant if you have other major health problems, such as serious heart, lung, liver, or kidney disease. Some transplant centers will review these problems and talk with you about your options.

A mini-transplant may be a better option. This procedure is described under allogeneic (allo) stem cell transplant in Types of Stem Cell and Bone Marrow Transplants.

Cost of a stem cell transplant

Costs vary depending on the type of transplant, but all stem cell transplants have a high cost.

  • Getting a donor's cells costs more than collecting your own cells.
  • Some medications and radiation treatments used to destroy bone marrow can have higher costs.
  • Some transplants require more time in the hospital than others, and this can affect cost.

Learn more about health insurance options and the cost of cancer care in Financial and Insurance Matters.

Insurance coverage and out-of-pocket costs for SCT

For some types of cancer, especially some solid tumor cancers, certain types of transplants are not the standard for treatment and insurers might not cover the cost.

No matter what illness you have, it’s important to find out what your insurer will cover before deciding on a transplant. Go over your transplant plan with them to find out what’s covered.

Ask about insurance coverage for:

  • Donor match testing
  • Cell collection
  • Medication and radiation treatments
  • Hospital stays
  • Follow-up care

Ask your insurer if the doctors and transplant team you plan to use are in their network, and how reimbursement will work.

Getting help understanding your expenses

Some larger insurance companies have transplant case managers. If not, you might ask to speak with a patient advocate or patient representative.

You can also talk with financial or insurance specialists at your doctor’s office, transplant center, or hospital. They can help you understand what expenses you’re likely to have, including how much you might have to pay out of pocket in co-pays and/or co-insurance.

Preparing for your stem cell transplant

The transplant experience can be overwhelming. A stem cell transplant often requires being in the hospital and being isolated. It can involve major changes for your body, family, and everyday life.

Your transplant team will be there to discuss your needs and help you prepare for the process physically and emotionally. They will make every effort to answer questions so you and your loved ones fully understand what will happen as you go through transplant.

It takes months and years to go through the transplant process, including recovery. This process can put you, caregivers, and loved ones at risk for anxiety and depression. It’s important to talk about your feelings and ask for help.

Choosing a caregiver

It’s important to have the support of those close to you. It’s also very important to choose a caregiver (an adult) who will commit to being involved in your care throughout your transplant process.

Sometimes, more than one person can act as your caregiver. You will need to choose a caregiver early on, usually during eligibility testing.

The role of caregiver involves:

  • Getting trained: Attending bone marrow transplant (BMT) caregiver classes.
  • Attending appointments: To understand what’s going on with your care.
  • Having good transportation: A reliable way to drive you to appointments.
  • Managing medications: Picking up from the pharmacy; making sure you take medicines at the right times.
  • Watching for problems: Looking for things like skin changes or fever.
  • Preparing food: Helping you fix meals and keep track of what you eat.
  • Advocating for you: Helping you speak up for your needs.

 

If your transplant is outpatient, your caregiver will need to be with you all day, every day. They can expect to be with you at appointments for the first 100 days or 1–3 months after transplant, or until you can care for yourself without much help.

Your transplant team will teach you and your caregiver what you need to know. The team can also help you and your loved ones prepare for the ups and downs that you may go through during the transplant.

Learn more in How to Communicate as a Caregiver.

Getting a central venous catheter (CVC)

Before your stem cell transplant, you may have a central venous catheter (CVC) put into a large vein in your chest.

This is most often done as outpatient surgery. Most people only need local anesthesia (the place where the catheter goes in is made numb, but you are still awake). Your transplant team will use the catheter to draw blood and give you medicines, stem cells, and blood products (if needed).

If you’re getting an auto transplant, you get a special IV catheter that can also be used to remove (harvest) your stem cells.

The CVC will stay in during treatment and for some time afterward, usually until your transplanted stem cells have engrafted and your blood counts are on a steady climb to normal. This may be around 1–3 months.

Managing side effects

There is a high risk of side effects. Many of these side effects are short-term, but some problems can go on for years and may be lifelong. Some side effects are unpleasant and can be serious. (Learn more in Stem Cell Transplant Side Effects.)

Your transplant team will work closely with you to help make you comfortable. You might also work with a palliative care team. For some people, side effects may not be completely controlled or relieved.

Where you will get your transplant (hospital or outpatient)

Your transplant team will decide the best place for you to get your transplant. The options are:

  • In the hospital: Stay for transplant and through your blood count recovery (2–3 weeks).
  • At an outpatient center: Transplant at an outpatient center, followed by daily appointments until you’re ready for less.
  • Short hospital stay: In the hospital for the transplant and an overnight stay, then discharged. Go to daily appointments at the transplant center.

If you stay in the hospital

If you stay in the hospital, you will probably go in a day or more before your pre-transplant chemo or radiation treatment begins (see the next section). The transplant team makes sure you and your caregivers understand the process and are ready to move forward.

How long do you stay in the hospital after a stem cell transplant?

Your stay in the hospital depends on the type of transplant you get. If you have problems like infections or delayed blood cell count recovery, your stay can be longer.

The usual hospital stay is:

  • Autologous (auto) transplants: 2 weeks
  • Allogeneic (allo) transplants: 3–4 weeks

What happens during your hospital stay?

The hospital will give you special instructions to prepare for your stay. Some things that may be included:

  • Visitors might be limited. (If someone is sick, they can’t visit you.)
  • Visitors can’t use your restroom.
  • You will have to stay in the transplant rooms and hallways (no visits to other rooms or floors).
  • No fresh plants or flowers.

Usually, people who have transplants and stay in the hospital are in a separate, special part of the building to keep as many germs away as possible. To reduce the chance of infection during treatment, people are put in private rooms that have special air filters.

The room may also have a protective barrier to separate it from other rooms and hallways. Some have an air pressure system that makes sure no unclean outside air gets into the room.

If you have all or part of your transplant as an outpatient

The transplant team will watch you closely to see if you have any problems, so expect to be at the clinic every day for a few weeks. You will get instructions on avoiding infection. If a problem comes up, you may have to go into the hospital to be treated.

For both in-hospital and outpatient transplants, you’ll need to be near the transplant center during the early stages. Some centers will tell you how many minutes away you need to live so that if a problem comes up, your caregiver can drive you to the transplant center.

 

Having a transplant takes a serious commitment from you, your caregiver, and your family. It’s important to know exactly what to expect.

Once conditioning treatment begins, there is no going back. There can be serious problems if treatment is stopped at any time during transplant.

Conditioning treatment (chemo and/or radiation therapy)

Conditioning treatment (also known as pre-transplant treatment, bone marrow preparation, or myeloablation) is the first step in the transplant process. Usually, it is treatment with high-dose chemo and/or radiation therapy. It typically takes 1 to 9 days.

Why is conditioning treatment done?

Conditioning treatment is done for one or more of these reasons:

  • Destroy any remaining cancer cells in your body
  • Suppress your immune system to lessen the chance of graft rejection
  • Make room in your bone marrow for the transplanted stem cells

The conditioning treatment is different for every transplant. Your treatment will depend on the type of cancer you have, the type of transplant you’re getting, and any chemo or radiation therapy you’ve had in the past.

How is conditioning treatment given?

If chemo is part of your treatment plan, it’s given in your central venous catheter and/or as pills.

If radiation therapy is part of your treatment plan, it’s given to your entire body (called total body irradiation or TBI). TBI may be given in a single treatment session or in divided doses over a few days.

Some conditioning treatments include both chemo and TBI.

Conditioning treatment side effects

Very high treatment doses of chemo and radiation are used, and the side effects can make you sick. It may take you months to fully recover.

Common problems are:

Conditioning can also cause premature menopause in women and often makes people sterile (unable to have children). See Stem Cell Transplant Side Effects to learn more.

 

Fertility planning before treatment

If you are interested in having children, it’s important to talk to your transplant team before you start any treatment and before transplant. You might have options for preserving your fertility (ability to have children).

Infusion of stem cells

After conditioning treatment, you’ll have a couple of days to rest before getting stem cells (called an infusion).

How is the stem cell infusion given?

The stem cells will be given through your central venous catheter, much like a blood transfusion. The length of time it takes to get all the stem cells depends on how much fluid the stem cells are in.

If the stem cells were frozen, you might be given medications before you get the stem cells. This helps reduce your risk of reacting to the preservatives in the frozen cells.

The frozen stem cells are thawed in warm water then given to you right away. There may be more than 1 bag of stem cells. If there is more than 1 bag, each bag is thawed after the previous one is given.

For allo or syngeneic transplants, the donor cells are collected from the donor’s bloodstream or harvested (removed) in an operating room.

If the donor isn’t at your hospital, a trained courier will bring the cells there. The cells are processed in the lab right away. Once they are ready, they are brought into your room and given to you through your bloodstream. The cells are fresh, not frozen.

The day you get the stem cells is called day zero. You will be awake for this process, and it doesn’t hurt. Every day after day zero is called +1, +2, and so on.

Infusion side effects

Side effects from a stem cell infusion are rare and usually mild. Most side effects are caused by preservatives in the frozen stem cells.

Smell and taste from preservatives

People say there is a smell and taste when the stem cells are infusing. They describe this as:

  • A strong taste of garlic or creamed corn in your mouth. Sucking on candy or sipping flavored drinks during and after the infusion can help with the taste.
  • Your body will also smell like this. People around you may notice, but you might not even smell it.

The smell and taste may last for a few days, but they slowly fade away. Using peppermint or coffee grounds in the room will often help offset the odor.

People who have transplants from cells that weren’t frozen don’t have this problem because the cells aren’t mixed with preservatives.

Other possible side effects

Other possible side effects during and right after the stem cell infusion might include:

  • Fever or chills
  • Shortness of breath
  • Hives
  • Pain or tightness in your chest
  • High blood pressure
  • High heart rate
  • Coughing
  • Chest pain
  • Urinating less than usual
  • Red color in your urine
  • Feeling weak

Again, side effects are rare and usually mild. If they do happen, they are treated as needed. The stem cell infusion must always be completed.

Recovery after the infusion

The recovery stage begins after your stem cell infusion. You’ll be in the hospital or visit the transplant center daily for a number of weeks.

What happens during the recovery stage?

During this time, you will wait for the stem cells to engraft or “take.” After the stem cells “take,” they start to multiply and make new blood cells.

How long does the recovery stage last?

You will stay in the hospital or be watched closely until your red and white blood cells and platelets start to return to normal. This usually takes about 2 to 6 weeks. The exact amount of time is different for everyone and depends on the transplant type.

Preventing infection during your recovery

During the first couple of weeks, you’ll have low numbers of red and white blood cells and platelets. Right after transplant, when your counts are the lowest, you may be given these medications:

  • Antibiotics to help prevent infections
  • Antifungals to help prevent fungal infection
  • Antivirals to help prevent viral infection

These medications are usually given until your white blood cell count reaches a certain level. Still, you can have problems, such as:

IV antibiotics and transfusions

Many people have high fevers and need IV antibiotics to treat serious infections. Transfusions of red blood cells and platelets are often needed until the bone marrow starts working and new blood cells are being made by the infused stem cells.

Extra precautions

People around you need to take extra precautions so you aren’t exposed to germs. While you are in the hospital, everyone who enters your room must wash their hands well. They might also wear gowns, shoe coverings, gloves, and masks.

Side effects during the recovery stage

  • For all types of stem cell transplant: After any type of stem cell transplant (auto, allo, or syngeneic) you may have stomach, skin, heart, lung, liver, or kidney problems.
  • Graft-versus-host disease (allo transplants): Graft-versus-host disease (GVHD) is a potential side effect that only happens with allo transplants.

See Stem Cell Transplant Side Effects for more details.

Discharge from the hospital after transplant

The discharge process begins weeks before your transplant. It starts with figuring out who will be your primary (main) caregiver and who will be the back-up caregiver if your main caregiver gets sick and can’t be near you.

In the weeks before transplant, the transplant team will teach you and your main caregiver:

  • About the job of caregiver and what to expect
  • The precautions you’ll need to take
  • How to prepare your home
  • How to care for your central venous catheter
  • How to take good care of your mouth and teeth
  • What foods you should and shouldn’t eat
  • Activities you can and can’t do
  • When to call the transplant team or other health care providers

What needs to happen before you can go home?

For the most part, transplant centers don’t send people home after transplant until they meet certain criteria. 

This could include: 

  • No fever for 24–48 hours (the exact time frame will be provided by the transplant center)
  • Able to take and keep down medications by mouth for 48 hours
  • Able to eat and drink
  • Nausea, vomiting, and diarrhea are controlled with medicine
  • Someone is available to help at home, and the home environment is safe and supportive

And blood levels:

  • Neutrophil count (absolute neutrophil count or ANC) is at least 500 to 1,000/mm3 and there’s a steady climb in numbers
  • Hematocrit is at least 25% to 30%
  • Platelet count is at least 15,000 to 20,000/mm3 and there’s a steady climb in numbers

For more information about neutrophils, platelets, and hematocrit, see How Does a Stem Cell Transplant Work to Treat Cancer?

Post-stem cell transplant (rehabilitation)

The process of stem cell transplant doesn’t end when you go home. You’ll feel tired, and some people have physical or mental health problems in the post-transplant period. You might still be taking a lot of medication.

Caregiver and friend/family support is very important to manage these ongoing needs at home.

How often will you see your transplant team?

During post-transplant care, your team will still watch you closely.

You might need daily or weekly exams along with things like blood tests and supplement replacements (magnesium, potassium, or others). You also might need blood and platelet transfusions, antibiotics, or other treatments during the early part of post-transplant care.

At first, you’ll have visits with your transplant team every day or every other day. You’ll progress to less frequent visits if things are going well.

Risk of infections after transplant

Your immune system will take some time to recover after transplant. You will be at risk for infections while your body recovers.

It can take 6 to 12 months, or even longer, for your blood counts to get close to normal and your immune system to work well.

Your chance of infection decreases when you:

  • Are more than 2 years post-transplant
  • Are off medications to suppress your immune system
  • Don’t have GVHD (if allo transplant)

Vaccinations after transplant

The transplant wipes out all the vaccinations you got as a child to protect your immune system. Your transplant care team will give you a vaccination schedule to get these vaccinations again.

What problems can happen during this time?

Some problems might show up as much as a year or more after the stem cells were infused.

This could include:

  • Graft-versus-host disease (in allo transplants)
  • Infections
  • Lung problems that make it hard to breathe (such as pneumonia or inflammation)
  • Kidney, liver, or heart problems
  • Low thyroid function
  • Overwhelming tiredness (fatigue)
  • Limited ability to exercise
  • Slowed growth and development (in children)
  • Cataracts
  • Reproductive or sexual problems like infertility, early menopause, pain or discomfort during sex, or loss of interest in sex
  • New cancers caused by conditioning treatments used for the transplant

Other problems can also come up, such as:

  • Memory loss, trouble concentrating
  • Emotional distress, depression, body image changes, anxiety
  • Social isolation
  • Changes in relationships
  • Changes in how you view the meaning of life
  • Feeling indebted to others
  • Job and insurance concerns

Your transplant team is still there to help you, even though the transplant happened months ago.

It’s important that you tell them about any problems you have. They can help you get the support you need to manage the changes you’re going through. They can also help you understand if problems are serious or a normal part of recovery.

Resources

The NMDP Patient Support Center helps patients and caregivers before and after transplant with emotional support, practical resources, financial grants, and educational information.

National Bone Marrow Transplant Link helps patients, caregivers, and families by providing information and support services before, during, and after transplant.

BMT InfoNet provides information and support for bone marrow/stem cell transplant and CAR T-cell recipients and their loved ones.

Learn more

side by side logos for American Cancer Society and American Society of Clinical Oncology

Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).

American Society of Clinical Oncology (ASCO).  Bone marrow aspiration and biopsy. Accessed at cancer.net. Content is no longer available.

American Society of Clinical Oncology (ASCO).  Side effects of a bone marrow transplant (stem cell transplant). Accessed at cancer.net. Content is no longer available.

American Society of Clinical Oncology (ASCO). What is a stem cell transplant (bone marrow transplant)? Accessed at cancer.net. Content is no longer available.

Chao NJ. Collection and storage of umbilical cord blood for hematopoietic cell transplantation. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/collection-and-storage-of-umbilical-cord-blood-for-hematopoietic-cell-transplantation on March 10, 2025.

Chao NJ. Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-grading-of-acute-graft-versus-host-disease on March 7, 2025.

Food and Drug Administration (FDA). FDA approves cell therapy for patients with blood cancers to reduce risk of infection following stem cell transplantation. 2023. Accessed at https://www.fda.gov/news-events/press-announcements/fda-approves-cell-therapy-patients-blood-cancers-reduce-risk-infection-following-stem-cell on March 3, 2025.

Fraebel J, Engelhardt BG, Kim TK. Noninfectious pulmonary complications after hematopoietic stem cell transplantation. Transplantation and Cellular Therapy. 2023; 29(2):82-93. Accessed at https://doi.org/10.1016/j.jtct.2022.11.012 on March 13, 2025.

Hibberd PL, Kotton CN. Immunizations in hematopoietic cell transplant candidates, recipients, and donors. UpToDate. Accessed at https://www.uptodate.com/contents/immunizations-in-hematopoietic-cell-transplant-candidates-recipients-and-donors on June 2, 2025.

Kaner RJ, Zappetti D. Pulmonary complications after autologous hematopoietic cell transplantation. UpToDate. 2024. Accessed at https://www.uptodate.com/contents/pulmonary-complications-after-autologous-hematopoietic-cell-transplantation on March 13, 2025.

Lv M, Gorin NC, Huang XJ. A vision for the future of allogeneic hematopoietic stem cell transplantation in the next decade. Sci Bull. 2022; 67(19):1921-4. Accessed at https://doi.org/10.1016/j.scib.2022.09.004 on March 3, 2025.

National Cancer Institute (NCI). Pediatric Hematopoietic Stem Cell Transplant and Cellular Therapy for Cancer (PDQ®): Health professional version. 2024. Accessed at https://www.cancer.gov/types/childhood-cancers/hp-stem-cell-transplant on March 7, 2025.

Negrin RS. Donor selection for hematopoietic cell transplantation. UpToDate. 2022. Accessed at https://www.uptodate.com/contents/donor-selection-for-hematopoietic-cell-transplantation on March 12, 2025.

Negrin RS. Preparative regimens for hematopoietic cell transplantation. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/preparative-regimens-for-hematopoietic-cell-transplantation on March 14, 2025.

Last Revised: July 10, 2025

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

American Cancer Society Emails

Sign up to stay up-to-date with news, valuable information, and ways to get involved with the American Cancer Society.

Sign Up for Email

Help us end cancer as we know it, for everyone.

 
Charity Navigator 4-star rating button     BBB rating button    Candid rating button